Middlemore is My Hospital

This is an address I gave at the opening of Ko Awatea in 2011. In some ways this is where The Medicine Stories Project started. Having put my thoughts down here I found it hard to shut up and walk away from them. Reading through it again I realised it will go up on the site the same week my niece will start her nursing training at the Manukau Institute of Technology. She has been working as a volunteer for a couple of years now at Kidz First. It seems Middlemore is still the family hospital.

Ko Middlemore te hōhipera

Middlemore is my hospital

My grandmother began in that lane that runs from the top of Miles Avenue through to Wallace Road in Papatoetoe, though there were traces of her from the time you entered the street at the top of the hill where it joins into Fairview Road. There was a zooming down the gully on my bike, a short coast halfway up the other side and then the long narrow lane. On one side loomed a large wooden villa, a home for old nuns. On the other side, over a green corrugated iron fence was Nana’s house. The lane and the green and the corrugated iron all seem part of her now, a memorial anatomy.

Nana was straight-backed. If you lived in Papatoetoe long enough you would have known her as the old woman who rode her bike down Curruth Road long after everyone stopped riding bikes. She would have been in her late sixties, and on the way to visit us in Puhinui Road. She sewed our clothes and knitted for us and had a way of clearing her throat that signaled displeasure. We were Seventh-Day-Adventists but she let us dip our biscuits in her tea out of sight of my parents and sometimes encouraged us to drink it. For all her sense of propriety, she retained a sensible rebellion. Her hair was tightly curled and unruly. It made her handsome rather than beautiful.

She died down the road, here in Middlemore Hospital. I was twenty-three at the time, long before I considered medicine as a career. I remember standing over her bed in the coronary care unit. She was pale and small and tired. I was comforted by the whiteness of her sheets and the way her bed held her neat in its hand, and by the steadiness of the cardiac monitor pulsing above her bed. I had no idea what its lines meant then, but they moved and glowed as if evidence of life itself. Hours after being reassured, she ruptured her intra-ventricular septum and died. My mother told me her heart had burst and I have always preferred that explanation. Her death is associated in my mind with the polished linoleum of the corridors that criss-crossed the hospital then, and by the funereal plywood panels that reached up the walls, as though the whole building itself was a casket. She is a spirit here now. I like to think of her riding her bike up and down the corridors of Middlemore, cutting between people or through them, her curls flying out behind her like the tail of a comet.

Pop, her husband, died in Middlemore as well, in the same coronary care unit thirteen years earlier. That last night I spoke to her, Nana pointed out the bed he had been in. He was a builder and painter and more than a few houses you pass in Papatoetoe on the way to the hospital were built by him or by my father a generation later. I grew up having them recited to me whenever we drove past: Kolmar Rd, Great South Rd, Omagh Ave, Tui Rd, Shirley Rd, Hillcrest Rd. He spent hours telling me as a child of his exploits in World War II. He had been sent to blow up a bridge that the German army was advancing over. After setting the charge he waited out of sight. The soldiers tested the bridge by walking the women and children of a local village across it. Pop waited until they had passed and the heavy artillery was mid-river, before bringing the whole thing down. Pursued by the remnants of the force, he leapt into the river and swam, bullets piercing the water around him. He stayed underwater until the Germans stopped searching for him, breathing through a broken reed. Really he had spent the war building a factory for mining sulphur on White Island, just off the Bay of Plenty. If he went to hell for lying he would at least be used to the smell.

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A hospital is a city between the living and the dead. When Odysseus visits the underworld he digs a pit in the soil with his sword, out of which the dead stream upwards. When Māui attempts to win eternal life he enters the vagina of Hine-nui-te-pō, the great goddess of death, in order to reverse the process of birth. It is here that hospitals belong, deep inside all pits and tunnels. Within them we attempt similar feats of defiance and passage. And inside them we have the same commerce with the dead. Maybe that is why they are so full of corridors. Lives begin and end here, or perhaps they simply change phase. Who can say? Either way, hospitals are not only holey, they are holy. I’m sure there are those who have called Middlemore a great vagina in the past. I am less sure they have meant to invoke the same mythologies.

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My father did not die in Middlemore, but he did go mad here. In Ward 22 to be exact. He was living around the corner at the time and had suffered from Parkinson’s disease for twenty-five years. His body unravelled in that way bodies do at times, the pillars toppling into each other like Samson bringing down the temple upon itself. The end began simply enough with a urinary tract infection which led to what we thought was a delirium. He was admitted to Ward 22 but he did not get better. The infection cleared but not his mind and he was diagnosed with Lewy-body dementia. Looking back, the madness had been approaching steadily but surely for a long time, but we had tried to shake it off. We knew he was in trouble when he rang my mother shortly after his admission, using a phone box just down the road. He said he had been discharged and asked her to pick him up. She rang the ward, who said he was tucked up in bed – until they checked. He lived out the next few years in a dementia unit in Parkhaven, not far away. We had picnics there every couple of months with his mad friends, who in a strange way entered the family. Medicine confers on those who practise it the knowledge of how their loved ones will die. We see the weapons arrayed and wonder at times which will be turned on us. It allows us warm deaths in a way, the feeling of being slaughtered by a friend perhaps, knowing exactly what is to come once they slip out of the shadows.

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For the first two years of my clinical training I spent as many runs as possible at Middlemore. I learnt to draw blood here. Our lecturers advised us to practise on each other. My lab partner and I did this once, looked each other in the eye and knew that was never going to happen again. From that point on I joined the phlebotomist on her rounds and practised on patients. That was what they were here for after all. It was a good way to learn the dark arts, and a useful guide to every nook and cranny of the hospital. Veins and corridors have a lot in common, a random evolution.

I learnt about the power of compassion here as well. It arrived in the person of Professor Sir John Scott, who looked after me on my first medical run. He seemed to practise medicine by magic. It’s true his knowledge was encyclopaedic but he had something different. Perhaps it was the practised acquisition of thousands of experiences in medicine that made his manner effortless, but I suspect there was more to it than that. He had a way of being with people that attracted their pains to the surface, where he would nod and smile with sad eyes. When he put his hands on people he did not so much take some secret knowledge from this, but infused some sort of medicine into them and calmed them. He had a way of talking and touching that was healing in itself. Years later that image haunts me when I feel the same sense of frisson with a patient. It leaves me pondering exactly what does happen between doctors and patients. What passes between us when we are with each other that we do not see, but sense sometimes like a shiver?

In 1995 I lived two months of my life in the department of obstetrics and gynaecology at Middlemore Hospital. I was sitting my final exams in medicine and its library was one of those out-of-the-way places I had found to hide and get things done. I studied with my friend, Josh Tutone. We made up notes and tested each other and sweated through old papers to get ourselves in shape. Later we would drive down to the shops just over the bridge on Massey Road and eat Burger King or KFC to return to the shapes we began with in the first place. We were South Aucklanders after all, and it was our cuisine. There is a special love reserved for those who have been comrades through such endeavours. When I think of the causes of anaemia or of peri-natal bleeding or of vaginal discharge I think of that room and of Josh now and wonder if he thinks of me. We might test each other still, counting off answers on our fingers and sweating over the ones which always stubbornly refuse to arrive.

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In our family photo album there is a picture of my youngest sister as a baby in an incubator. She is swaddled and asleep and looks like all well babies born at term, snub-nosed and condescending. She was born on a Sunday at half past ten in the morning, the fourth child in the family, and she gave my mother little trouble. The labour was over and done within a morning, only a little longer than it would take to get us all off to school on any given day for the next fifteen years. Faced with a choice between the two options again, I feel my mother would choose the labour most days. Her birth took place in this hospital forty years ago, although my sister might say thirty-nine. Elsie Olive Murray, Nana’s mother and my daughter’s namesake, died here in 1966 after a stroke. Her husband James did as well, six years earlier, three weeks after a heart attack and the day before he was to be discharged. Most of my nieces and nephews have taken their turn waiting in the emergency department here to deal with the assorted fevers, lacerations and broken bones of their childhood. I have even had my car stolen from the hospital carpark, a rite of passage for all who belong to this community. All in all, five generations of my family have been born, treated, trained, and died in Middlemore. It is our family hospital if such a thing exists, and I very much hope it does.

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The ’60’s and ’70’s were a wonderful time to be part of South Auckland. Māori and Pacific Island families were flooding into the area. Papatoetoe slowly became a smaller and smaller white island surrounded by the great brown suburbs of Ōtāhuhu, Ōtara, Manurewa and Māngere. For all that, it was the potato salad that undid me. I first ate it at the opening of the Ōtara Seventh-Day-Adventist church my father built. My family were seated at an impossibly long table sagging with all sorts of new and wonderful food and right in front of me was a glistening mound of mayonnaise decked on as small a garnish of lettuce as possible, a flimsy green tutu on a great white elephant. It reminded me of a freshly draped abdomen the moment before incision. Inside it dripped with blood. Beetroot and potato and mayonnaise sat on my plate like a sexy autopsy. Here was the perfect blend of Palagi and Polynesian in something as mundane as potato salad. The possibilities we offered each other seemed endless. South Auckland was sensual and funny and excessive. This was its food and I was its child.

During those years, many Palagi in Papatoetoe fled to Howick or the Gold Coast, but my family stayed and fell in love. Six of my mother’s eight grandchildren are Samoan or Māori. All are Pākehā or Palagi as well. We were blended. It was an experience of being Pākehā that has dominated my medicine and my writing since. When I started my training in Middlemore there was no other place I wanted to be. There were few architectures in my city then which combined brown and white so markedly, skinny pinched old Pākehā on their thin hospital gurneys, a single relative sitting quietly beside them, and great Polynesian bodies welling over the sides of their beds like well-browned loaves of bread while a scrum of kids dismantled the waiting room around them. We bled and laughed and died here together in a shitty old building next to a golf course distressingly green and King’s bloody College – as if God himself was taking the piss. This is my home. An Air New Zealand 747 on final approach over Manukau City Centre is my mountain, the great southern motorway is my river, the sewage ponds glistening under Māngere mountain in a westerly are my moana and Middlemore is my hospital. These landscapes are with me everywhere I go. I am creamy-brown.

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South Auckland is the richest melting pot of peoples that we have in our country and it is extraordinarily valuable to us because of that. Older, more established cultures bend and change there as new ones impact upon them and change themselves in the process. It is the human equivalent of a fault line: Europe, the Pacific, Asia and even Africa now grind together, buckling and twisting a cultural landscape complete with folded hills, soaring mountains and sharp escarpments. For so long it seemed to be a place that was shunned, however – perhaps for that very reason. It was ragged and dangerous and poor. Mainly it was misunderstood. For me one of the surest paths to understanding in that maelstrom of meeting has been in talking to each other. When we went to each other’s places and listened to each other’s stories we started to recognise the same themes: love, hope, sorrow, longing and decision. There were few architectures of our meeting in the South Auckland of my youth. Playgrounds, schools, the odd shopping centre, swimming pool or church but none particularly shaped like those of us being bent or reflecting that bending. It was a city of churches and KFC with the blunt black pencil of the southern motorway ruled through it. The airport was distinctive but scrubbed clear of too much brown. Visitors were quickly escorted out of the south to our harbours or volcanoes and kept away from the generative forces that gave rise to equally powerful shapings.

Middlemore was our architecture and did not run in the face of what seemed ugly on the surface. It mixed our bloods literally, cleaning up after us on Friday and Saturday nights, scrubbing our vomit and piss and shit off its floors. We howled here with Polynesian abandon and we sniffed parsimoniously into our Victorian hankies, stiff upper lips quivering until we eventually understood the grief behind both ways. It was a dump but so was the whole suburb. It was our dump though, and its crazy, nonsensical corridors and add-ons and add-ons to add-ons seemed to reflect the conflicts and resolutions taking place all over our city. Slowly, extraordinarily slowly it rose out of the impact of our various cultures and stories to reflect and protect us like some strange transformer, gleaming at full stretch out of a rusted old car body beside the railway tracks, our very own Optimus Prime. Those who couldn’t abide who we were left, and those who stayed grew to love us until they were part of us as well.

Architectures are important because they house us. Five generations of my family have bled in one way or another in Middlemore. It has rubbed off on us and we have rubbed off on it. It is a marae of sorts, our ghosts lie here and inform it, along with the ghosts of those who have shared this piece of dirt with us. I am spooky enough to believe in ghosts after twenty years of medicine and I can’t help thinking that all the dead of Middlemore somehow give it lustre and dimension and a powerfully fecund doubt. But architectures are also important because they physically represent or point towards our states of mind, reflecting what we are thinking and helping to stake that territory. They provide a fulcrum to lever ourselves further into the great conversations of identity. Middlemore is an architecture of the South Auckland soul. It is shaped by us but also shapes us. There is a Middlemore of wood and steel but there is also a Middlemore of the imagination. This hospital has a place in our cultural lives. We all know it and our stories feature in it. To me it represents humanity in the face of difference. It is an institution that has thrown its lot in with the community it is part of. It has been poor when they have been poor, dirty when they have been dirty, as irrational and tangential and infuriating as all of us. And it has become ours. Above all else it has stayed and it has endured and it has become kind when it could have despaired. It has seen that we are funny and beautiful and generous and proud.

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Human beings live in communities, as do their illnesses. Because of this, hospitals in the fullest sense belong in and to those communities. One entity establishes an equilibrium with the other. It is supposed to be polite, a gentleman’s agreement. But Middlemore never had a say in any of this. The community it served refused to draw any boundaries between their lives and its doors. They opened the gates and came right in as if they owned the place. The hospital flooded with a sea of humanity because in an old-fashioned way that humanity expected their hospital would be there to care for them. They did not suffer from the mad sophistication medicine sometimes fractures into, which stammers care into bundles and denies its ability to just shut up and kiss us. The irony is that what Middlemore found under that sea preserved its soul in important ways. Perhaps it was my Pop showing them how to breathe underwater. I have lost count of the times that patients save their doctors’ lives and see no reason why the same should not be true of a hospital as well. It would be a perilous thing for Middlemore to forget the debt it owes to its community, no matter how it might whinge about late presentations and overcrowding and seeing your GP first and decile levels. How often in life is it the sea that saves us from drowning?

Human beings also exist in relation to big questions. Who am I? What is of value? How should I act? Perhaps most compelling of all, am I important? In general practice so often the management of someone’s illness rapidly defaults to these questions. Human beings are spiritual and this spirituality is the most powerful medicine we possess. Where it is present no illness can erode, and where it is absent no physiology, however pristine, brings a sense of ease. At the end of the day biology turns into chemistry and chemistry turns into physics and physics turns into maths. In a similar way there is an open border between medicine and spirituality and for me ‘spirituality’ is simply another way of saying ‘our stories’. Our stories tell us who we are and how to act. They tell us what we are worth. They also move with time, providing points of entry and exit into our lives. Interacting with someone’s story is almost always more effective than fooling around with their medications. As a doctor I need to know about the pharmacology of SSRI’s but I use Dickens and Woolf and my father and Nana much more often.

And so I come to my point. In a place where Middlemore considers its links to the cultural life of the community it is part of, I want to ask it to especially consider the spiritual lives of the people it serves. All medicine finally comes to this. Our stories are an intrinsic part of our well-being, and so please let Middlemore tell our stories, stories without fear or favour, stories told in music, in art and in literature, ones that show our beauty and our doubt. Let it reflect who we are and in doing so point the way to our becoming. Let it display them so that we can see what ails and what heals and so that we can see ourselves and compare.

Churches and universities have long been institutional patrons of the arts, but the stories that take place in hospitals at least match those that take place in these institutions, and often far outstrip them. Lives begin and end there. Why shouldn’t hospitals foster programmes in the arts? People look for answers to the big questions here, as much, if not more, than anywhere else. It is good medicine to preserve our anecdotes and to say that others have searched and search still to understand our fragile, blessed humanity, that here our vernacular exists, capable in the sum of its disparate parts of bringing succor, enlightenment, camaraderie and insight. Our spirituality is so awfully wounded in the twenty-first century West and our collective stories are still the best source of spirituality I know. Let there be somewhere in the hospital where the randomised controlled trial is balanced at least with the ruthless, intuitive, sensual subjective.

To conclude and to underscore that process, let me leave you with my own small South Auckland story composed in streets not far away a long time ago. My warm congratulations to you all on the opening of Ko Awatea. It is a brave and forward-thinking resource to build in a hospital, a narrow reed perhaps to breathe through as the bullets zip. Thank-you for your patience. Thank-you for your colour and for your noise. Thank-you always for your myriad ways of being human. I have never ceased to be your son.